Provider Demographics
NPI:1619685500
Name:HICKSFAMILYMEDICINEOHIO, LLC
Entity Type:Organization
Organization Name:HICKSFAMILYMEDICINEOHIO, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:STACIE
Authorized Official - Middle Name:
Authorized Official - Last Name:HICKS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-305-9856
Mailing Address - Street 1:102 W ASH ST
Mailing Address - Street 2:
Mailing Address - City:CONTINENTAL
Mailing Address - State:OH
Mailing Address - Zip Code:45831-9162
Mailing Address - Country:US
Mailing Address - Phone:561-305-9856
Mailing Address - Fax:
Practice Address - Street 1:102 W ASH ST
Practice Address - Street 2:
Practice Address - City:CONTINENTAL
Practice Address - State:OH
Practice Address - Zip Code:45831-9162
Practice Address - Country:US
Practice Address - Phone:561-305-9856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-09
Last Update Date:2023-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty